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Acute compartment syndrome in patients on long-term anticoagulation therapy

Matthew Mazur, Nour Jabaly, Nabil Ebraheim

Development of acute compartment syndrome (ACS) poses problems for patients on long-term anticoagulation, who are at higher risk for hemorrhagic insult. The populations predisposed to ACS and long-term anticoagulation individually are quite different, making this a particularly unique population that has been rarely studied. Eight patients at our institution were included in this study based on development of ACS while being on long-term anticoagulation. Causes of ACS were almost evenly split between idiopathic, fracture, and blunt trauma without fracture. The most commonly involved compartment was the lower leg. ACS was appropriately diagnosed based on clinical assessment alone in all patients, based on heightened level of suspicion. All patients were treated with single- or double-incision fasciotomy, as is the standard of treatment in the general population. All patients experienced good outcomes post-fasciotomy with prompt bridging to anticoagulant regimen, with minimal complications and no cases of mortality. These patients were not revealed to have any identifiably unique risk factors for developing ACS, and they can be treated similarly to patients not on anticoagulation and adequately bridged to therapeutic anticoagulation levels.